Clinical Neurology Unit, Santa Maria della Misericordia University Hospital, Piazzale Santa Maria della Misericordia, 15, 33100, Udine, Italy.
Clinical Neurology Unit, Santa Maria della Misericordia University Hospital, Piazzale Santa Maria della Misericordia, 15, 33100, Udine, Italy; DMIF, University of Udine, Udine 33100, Italy.
J Neuroimmunol. 2019 May 15;330:55-58. doi: 10.1016/j.jneuroim.2019.01.006. Epub 2019 Feb 21.
Tacrolimus-induced encephalopathy presents with acute neurological symptoms such as headache, seizures, visual disturbances, hemiplegia, and altered mental status. A 60-year-old woman, presented to our clinic with a 4-month history of severe headache. She recently underwent kidney transplantation and was taking tacrolimus. MRI scan showed diffuse and symmetric alterations involving both supratentorial and infratentorial white matter. Cerebral spinal fluid assessment for infectious diseases were negative but elevated total protein level and oligoclonal bands positivity were reported. Treatment with steroid bolus, along with tacrolimus tapering, provided clinico-radiological improvement. This is the first case of tacrolimus-induced neurotoxicity strongly suggestive of an immune-mediated pathogenesis.
他克莫司诱导性脑病表现为急性神经系统症状，如头痛、癫痫、视力障碍、偏瘫和意识状态改变。一位 60 岁女性因严重头痛到我院就诊，病史 4 个月。她最近接受了肾移植，并服用他克莫司。MRI 扫描显示弥漫性和对称性改变，累及幕上和幕下白质。脑脊液传染病评估为阴性，但报告总蛋白水平升高和寡克隆带阳性。类固醇冲击治疗联合他克莫司减量治疗提供了临床和影像学改善。这是首例强烈提示免疫介导发病机制的他克莫司诱导性神经毒性病例。
